I started researching low-carb keto diets over 20 years ago and I didn’t know much about nutrition. Like most doctors, I didn’t get much training in nutrition in medical school or in residency. I did an internal medicine residency and I did learn about total parenteral nutrition, which is what you give someone who’s very sick and can’t eat – tube feedings and then intravenous feedings. We didn’t learn much about nutrition in medical training and I’m afraid that’s still true today. I have to think that most of my doctor colleagues get their information from ads on TV or companies that want you to buy their products. For example, “How would you get vitamin C if you don’t have orange juice?” There’s more to nutrition.
Food is key to address when losing weight
Fast food gets a bad rap in terms of quality and many say that it can’t possibly be good for you. In fact, some of my doctor colleagues will inadvertently advise things that don’t work. There are no studies about them; my colleagues might say, “Just don’t eat fast food,” or “Just go home and eat less, exercise more, that’s how you lose weight and keep it off.” These are not approved ways. They don’t really work for … just about everyone. Sometimes, even the doctor will use what worked for them.
I’m in a clinic setting where I teach a low-carb keto diet. It’s pretty much a weight loss and diabetes reversal clinic now. We don’t tell you that you need to exercise to lose weight. If you have knee pain or arthritis so bad that you don’t even try to lose weight because you think you need to exercise to lose weight, that’s not true. You can lose weight by changing food, without exercise. Don’t let that be a barrier for you to start. Food is the answer. Food is critical and doctors get no training in it. For the most part, you really have to come up with your own information, yourself.
Make sure you are eating the essentials
Importantly, you want to get protein every day and you want to get some fatty acids every day. These are called essential nutrients – amino acids and fatty acids. If you eat animal protein sources, you’re going to get all of what you need. Meat, poultry, fish and shellfish, and eggs are the foundation of a properly formulated low-carb keto diet. Because we’re not worrying about a seizure or something catastrophic happening, we don’t have to teach about macros. We don’t teach you to worry about the fat and protein ratio at every meal, we don’t even teach you to monitor ketone levels. Although you can if you want to, it takes it away from the reach of most of my patients.
I cater to a wide range of patients
I’m in a clinic where it can be insurance or paid through Medicare or Medicaid. People shop at the fanciest grocery stores and they shop at the least expensive, or they go to fast food places. How am I going to help a patient who comes to me who is only eating at fast food restaurants? Should I tell them, “Don’t eat at fast food restaurants?” That person will never come back. I learned about this not by telling people to go ahead, it’s okay to eat at these fast food places, rather, I had patients coming back to me telling me after my teaching class who ate at fast food places and still lost weight.
The young man who only ate McDonald’s
I remember, vividly, this young man who only ate at McDonald’s and was down 10 pounds. If the weight’s down 10 pounds for the month, this person probably followed the plan. I started to probe a little deeper because he said he always goes to McDonald’s. I got into this because I saw patients in front of me do it and was curious to learn how they did it. He was basically eating the burgers with no bun. He was eating off what at the time was called the “dollar menu” at McDonald’s. He was having two to three double cheeseburgers, no bun, no fries, no sugar in his drinks (you can have diet sodas or water). Some days he was just not hungry and he ate one meal a day. He might have had two double cheeseburgers and he was satisfied with that meal. What I need to be sure of, whether you want variety or you’re happy with a little variety, is that you’re getting great nutrition. Through the years, the carnivore idea has grown. It’s a simple way to make food even less distracting. It might not be satisfying for everyone but you can actually get sufficient nutrition from mainly meat sources, if not all meat sources. You could add in some eggs and I’d be a little happier. I would worry less. Going back to the gentleman at McDonald’s, I had to think through, “Okay, he’s getting adequate nutrition while losing weight.” The hunger goes down so you start burning your own body fat and then the ketones come from your body fat – that’s where the idea of a keto diet comes from – ketones go up in the blood and then these are used for fuel in cells that used to use glucose. Even the brain can use ketones for proper function.
People started coming in having had weight loss surgery and wanting pills and shots and trying to balance all the different things while eating at a fast food place and this man basically did it every day. That, to me, is less risky than weight loss surgery. We criticize the weight loss surgery approach because you’ll lose some lean body mass; it’s hard to get enough protein at the beginning to support your muscles, so you’ll probably lose some muscle. Some people are not even being told what to eat and they’re given shots. This is a recipe for problems. You need to be sure you’re getting protein, fat, those essential nutrients and not having much sugar or ultra-processed food. We all agree now that that’s the thing to avoid. Any well-studied, balanced approach will minimize or eliminate the sugary, highly processed foods. This fellow lost somewhere between 50 and 100 pounds. I can’t track back to find him anymore, sadly, but I’ve incorporated and learned from him in my teaching. I don’t prohibit and I don’t even talk down about fast food and restaurants. I appreciate that some people can only eat there. You have to wonder why fast food places aren’t part of the solution for weight loss. You have to remember, though, that these companies are in the business of selling food, so why would they want to make you figure out a way that you could eat less? I think a progressive company like Subway could get in the game and say, “Hey, here’s a way to lose weight eating our food,” and then you embrace the low-carb concept. Keep the starches low, ditch the buns, have no fries. Fast food, it seems to me, is getting the signal that a lot of people don’t want to eat much carbohydrates at their establishment.
The short answer
Fast food can be part of a keto diet, keeping the carbs super low and focusing on having protein and fat, which is a major source of nutrition.
Watch the full video here.